Baseball Therapy: The Hard Part About Preventing Tommy John Surgeries

On Wednesday, we had a news story involving Drs. James Andrews and Glenn Fleisig and Tommy John surgery. Normally when that’s the case, it means that someone’s season is over (and sadly, that’s been happening a lot lately). But this time, it was the good doctors responding to what they termed an “epidemic” of ulnar collateral ligament transplants (the actual name for Tommy John surgery) and offering some helpful tips to prevent the elbow injuries that require the procedure.

I have absolutely no expertise in orthopedics, but I’ll trust that these guys know what they’re talking about. Their recommendations ranged from the obvious (exercise, rest, and nutrition are vital to a pitcher’s health) to the more earth-shaking (think twice about winter league baseball—can you do a winter league without pitchers?). To my untrained eye, the recommendations all make sense if the goal is to prevent UCL tears. Now, if all teams and pitchers would simply follow their recommendations…

Oh, if only making people healthier were that easy! We’d have a country filled people who had healthy weights, were non-smoking, were moderate drinkers, and about 50 other things.

So here comes the tough part. How on earth will we get pitchers to follow these rules? When reading through the steps that Drs. Andrews and Fleisig recommend, my first thought was about how many of these rules are broken on a regular basis. Not only that, but how many of them would be a hard sell to the actual players involved. Some of them would be easy enough—optimizing pitching mechanics is something that all pitchers want to do anyway. But I about spat out my drink when I read this:

“2. Do not always pitch with 100% effort.”

Well now, aren’t we contradicting just about every cultural message that a given pitcher has ever heard. Yes, he might have heard this advice from his pitching coach in the past, but we still live in a “Rah rah, give 110 percent all the time” culture. Consider the following: There’s a small fascination that people have with the idea that closers do not seem to pitch well in non-save situations. For example, sometimes a closer hasn’t pitched in five days and just needs an inning of work. Despite the fact that his team is actually down 7-1, he comes into the ninth. And he gives up two extra runs, not that it matters. I’m going to out on a limb and suggest that sometimes, that’s a pitcher not going 100 percent. He doesn’t need to, so why should he? Yet, when he’s asked about it after the game, it would be borderline heresy for him to say, “Yeah, I was just out there to get my work in. I wasn’t throwing everything 100 percent. Just trying not to get hurt.”

On top of that, there are plenty of incentives for a pitcher to give 100 percent all the time. When a pitcher is young, his job might not be to light up the radar gun, but if he’s being scouted, then there are probably a lot of radar guns behind home plate, and the more lights he turns on, the better the report. He might be able to get high school hitters out with less than 100 percent effort, but high school hitters vary so much from place to place that you can’t trust high school (or college) stats. You can trust velocity and movement, and that’s going to take some arm effort. Even in the minors, there’s the reality that minor league teams are more like American Idol than you might imagine. We might all be friends, but only one of us is going to get that meeting with the manager. If I throw at 90 percent to save my arm, and Larry throws at 100 percent, whom do you think the team will notice first? There’s an incentive for me and everyone else to throw at max effort.

In addition, the Andrews-Fleisig model calls for “open communication between a pitcher and [coaches] and medical staff” and says that “the pitcher should keep his trainer or coach up to date about any soreness, stiffness, and pain. That way when there is an issue, the player and team can consider rest, modified activity, or examination from the team physician to allow the elbow to heal and avert serious injury.” Just to be clear here, we’re asking for men to engage in open communication, to admit that they are in pain (despite all the cultural messages about playing through it), and to approach the people who control their playing time so that some of it can be taken away.

The reality is that if this plan is going to work, it’s going to take a complete change in organizational culture. While teams can’t control what happens at the amateur level, they can make it a point to scout for pitchers who have some idea of how to hold back a bit. Maybe some already do. It might also take some re-thinking of whether worshipping the radar gun is a good idea or whether, as Sam and Ben suggested on Thursday’s episode of Effectively Wild, teams might begin to prefer soft-tossers, like Mark Buehrle.

The part that teams can control is setting up a culture in which it’s okay to pitch at less than 100 percent, and in which players are rewarded for having the maturity not to air it out when the pitching coach politely asks them not to. They might have to make it clear that promotions are based, in part, on that maturity factor. But pitchers might still hesitate. Even if a team succeeded in building an ecosystem where restraint was a highly valued commodity, going at less than 100 percent will not make the stat sheet sing, and the wider market out there pays for what’s on that stat sheet. It might leave a pitcher in a situation where he’s thinking about scoring that one big contract. If he goes at less than 100 percent, he might not turn enough heads to make his money. If he goes all out all the time, he might blow out his elbow, but it might be the only chance he has to get paid, or to make the majors.

A progressive team might have to not only nurture a culture where “less than 100 percent” isn’t a dirty phrase when applied to the correct situations, but put their money where their mouth is and try to re-assure the pitcher, perhaps with a nice early extension, that they are committed to this plan and that he will get his money.

As for the issue of encouraging players to report their injuries, it is true that men, whether professional athletes or not, are famous for avoiding the doctor. Indeed, how many Tommy John stories have we heard that contain some reference to the fact that “He started feeling pain last month/year, but tried to pitch through it. It was only after Tuesday night’s game that the pain became unbearable and he had an MRI”? In order for a team to actually achieve “open communications,” it’s going to need to do some re-branding of what disclosing an injury is.

Thankfully, while male psychology provides a good amount of the problem, it also provides part of the solution. It’s no mistake that you often hear men in large groups (like, say, groups of 25) talking about how everyone in the clubhouse has banded together. That idea of a band—not in the musical sense, but in the sense of a group of people who are working together and who are loyal to each other—is a powerful one. A team that cultivates this feeling—dare I call it chemistry?—has a hidden edge if they play it right. Yes, it’s hard to admit that you might need to take a trip to the DL, but by hiding your injury, you are doing harm to the collective. If you simply admit what’s going on, it might not be great for you personally, but it will demonstrate that you are clearly a loyal and committed member of the band.

There are probably teams where this sort of re-branding of injury reporting is going on. The stakes are too high for there not to be—Tommy John does take 12-18 months for recovery, if you recover. (Plus, a torn elbow is not the only injury that needs preventing.) But it’s an interesting twist for the sabermetric audience—another very easily draw-able link between that lovely and nebulous idea of team chemistry and actual baseball value.

Yes, we have a nice roadmap for how to at least reduce the risk of elbow injuries. While it’s nice to have a map, you also have to know how to operate a car to get where you’re going. The actual implementation of the Andrews-Fleisig recommendations are going to be hard, and it’s going to take more than just monitoring pitch counts and investing in bio-mechanical analysis. This is something that has to be built into the very fabric of an organization.